Winston-Salem-based Novant reports operating income of $110 million in fiscal 2013.

That’s down 39 percent from $185 million in 2012.

Investment income rose to $163 million last year from $109 million a year earlier.

The health-care system remained “vigilant” in 2013 to control costs in a turbulent environment, says Carl Armato, president and chief executive of Novant Health.

He notes the market will remain challenging.

The health-care system knows it must “remain nimble” and continue to control costs, while focusing on delivering the best care possible to its patients, Armato adds.

“Strong financial results are necessary for us to reinvest in our communities, facilities and employees. A strong organization ensures our future ability to provide needed services,” he says.

Novant operates 15 medical centers and hundreds of outpatient facilities and physician clinics across four states. That includes Novant Health Presbyterian Medical Center in midtown Charlotte as well as facilities in Huntersville, Matthews and an orthopedic hospital.

Novant generates annual revenue of $3.6 billion.

The health-care system has seen an increase in the number of patients using its services. That includes a slight uptick in inpatient hospitalizations and emergency room visits, though both increased less than 1 percent in 2013.

Novant also saw costs tied to charity care for uninsured and indigent patients climb to $129 million, an increase of 5 percent from $123 million in 2012.

It provided $566 million in community benefit in 2013, which includes charity care, community outreach, free medical clinics for the uninsured and poor, and unfunded care tied to Medicaid and Medicare.

That’s up from $546.1 million in 2012.

In 2013, the organization served more than 130,500 individuals through community-health offerings such as health education, screenings, support groups.

It also provided professional education as well as additional community-outreach activities and investments focused on improving the health of communities.

For example, Novant provided free cancer education to nearly 16,300 people and cardiovascular screening to more than 13,000 patients identified as at-risk.

Strong financial years such as 2013 allow the health-care system to reinvest in new technology, hospital improvements, equipment and community-health needs, says Fred Hargett, chief financial officer.

“We have a responsibility to our patients to provide them with the very best care available,” he says. “A large part of that is ongoing investment in the tools needed to provide the highest degree of care.”

Novant spent more than $350 million in 2013 on construction projects, routine equipment replacements at facilities and implementation of its electronic-health record.

In 2013, all Novant physician clinics completed a rollout of the electronic-health record. That project was completed nearly three years early and under budget.

Details of those savings were not available, but Novant has projected it will cost $600 million for that conversion systemwide.